| NPI | 1548728058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NY 312738) |
| Additional Taxonomies | 208800000X Urology (Licence: NJ 25MA11722700) |
| Enumeration Date | 2019-03-05 |
| Last Update Date | 2024-05-28 |